Provider Demographics
NPI:1164397824
Name:CHILDREN'S HEART INSTITUTE
Entity type:Organization
Organization Name:CHILDREN'S HEART INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:571-612-2600
Mailing Address - Street 1:171 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4875
Mailing Address - Country:US
Mailing Address - Phone:571-612-2600
Mailing Address - Fax:571-266-4096
Practice Address - Street 1:10772 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3646
Practice Address - Country:US
Practice Address - Phone:571-612-2600
Practice Address - Fax:571-266-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty